In addition to the management of chronic sinonasal inflammatory problems the physicians at the Nasal and Sinus Disorders Program are experts in the management of sinonasal tumors.
A multidisciplinary approach is applied to the management of sinonasal tumors to maximize the chances of a long-term cure while minimizing patient risk and deformity.
Other specialties involved in patients care can include neurosurgeons, oculoplastic surgeons, facial plastic and reconstructive surgeons, oral and maxillofacial surgeons, hematology/oncology, neuroradiology, and radiation oncology. Utilizing the expertise available in these diverse fields, we create a comprehensive treatment plan tailored to each patient's needs.
Evaluation of Sinonasal Tumors
Patients presenting to the Nasal and Sinus Disorders Program with these tumors undergo a thorough evaluation. The preoperative evaluation will include a thorough head and neck exam, review of the microscopic characteristics of the tumor, and a detailed review of the radiographic imaging studies (CT and MRI).
The head and neck exam will include a procedure called nasal endoscopy. The endoscopes provide superior illumination and visualization of the tumor as compared to traditional techniques. When combined with the CT and MRI findings a precise "mapping" of the tumor can be accomplished preoperatively.
Depending on the microscopic characteristics, location, and extent of the tumor, appropriate consultation with the specialties noted above is arranged. An individualized plan is then tailored for each patient.
Treatment of Sinonasal Tumors
The management of sinonasal tumors can include surgery and/or radiation therapy. A variety of surgical approaches have been utilized to access these tumors.
In recent years the development of endoscopic techniques and image guidance systems has facilitated a less invasive approach to sinonasal tumor excision, without any compromise in the long-term cure rates. The intraoperative visualization and localization provided by these technologies often allows complete tumor excision while minimizing cosmetic deformity, complications, and hospital stay.
The following case demonstrates how a minimally invasive approach is used to treat sinonasal tumors. A 77 year old man presented with complaints of headache, facial pain above and below the eyes, right sided nasal obstruction, decreased smell and nose bleeds. Nasal endoscopy and imaging studies revealed a tumor of the right sinonasal cavity. Biopsy of the tumor revealed the tumor to be malignant.
Given the microscopic appearance, location, and possible extension of the tumor to the skull base neurosurgical consultation was obtained. After a thorough review of the endoscopic and radiographic findings the patient was taken to the operating room where a transnasal endoscopic excision of the tumor was performed using the image-guidance system.
No external incisions were required and tumor-free margins were obtained. Postoperatively there were no complications and the patient went home the day of surgery. He underwent postoperative radiation therapy and is tumor free one year after treatment. In the past, the patient would have had an external facial incision and a craniotomy resulting in cosmetic deformity, increased risk, and a prolonged hospital stay.